press releases/assisted news

“Help for the Sandwich Generation”
“The Fountain of Youth is Found in Exercise”
“Hospice Care: An Option at the End of Life”
"Shorter Hospital Stays? No Problem!"

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HELP FOR THE SANDWICH GENERATION
by Sherry Netherland

If you are tired of being called a "Baby Boomer," take heart, you may now fall into the "Sandwich Generation." The Family Caregiver Alliance estimates that between 20% and 40% of caregivers have children under age 18 to care for in addition to an aging relative. If you are female, you are 72% more likely than a male to be the one responsible.

The one arena of the health care field that continues to grow is home health care, and yet it continues to be the least understood. Home health care can be divided into three major categories: intermittent home health visits, private duty nursing, and home hospice care.

Virtually any service that can be provided to a patient in a hospital can be provided in the home utilizing intermittent home health visits. This evolvution of Intermittent Home Health Visits has kept pace with the shorter and shorter hospital stays. In addition to skilled nursing visits and rehabilitation therapies (physical, occupational, and speech), a patient can have an I.V. at home, oxygen, and even an X-ray. These services are ordered by a physician as dictated by the diagnosis, typically following a 3-day hospital stay. A patient does not always need a new diagnosis or in-patient stay, however, to qualify. An exacerbation of an existing illness, such as diabetes or multiple sclerosis makes a person eligible for home nursing or therapy. The only stipulation is that the patient be home bound. Home health visits are covered by Medicare, Medi-Cal, or private insurance.

The second type of care that can be provided in the home is Home Hospice Care. Hospice is a special way of caring for terminally ill patients, providing compassionate end of life care to patients and their families through a team of hospice professionals. The care that hospice provides is meant to help make the most of the last months of life by giving comfort and relief from pain. The focus is on care, not cure. Hospice benefits are covered through Medicare, Medi-Cal and most private insurance companies.

The third type of care found in the home is Private Duty Nursing. The predicament that many primary caregivers find themselves in is they don't have the luxury of being able to stay at home. The FCA fact sheet reveals that nearly two-thirds of family caregivers are employed outside the home. It can become a real necessity for families to rely upon private duty nursing services.

There are two types of private duty care - skilled and non-skilled. Skilled private duty care is provided by Licensed Vocational Nurses (LVN's) and is utilized in cases such as ventilator dependent patients, spinal cord injury patients, or medically fragile children. This type of care is typically reimbursed by private insurance or Medi-Cal. Non-skilled private duty care is known in insurance company lingo as "custodial" care. This is the most frequently needed category of private duty care. This type of care, unfortunately, is not covered by most insurance companies and definitely not by Medicare or Medi-Cal.

Too often we see members of our family obligated to move into nursing or retirement homes because their frailty or other medical condition would make it unsafe for them to be at home alone. They are not necessarily sick, they just have difficulty performing activities of daily living, such as bathing, grooming, eating properly, toileting, etc. It may not be possible for them to be completely independent because they cannot do their own grocery shopping or meal preparation. They may be forgetful about taking their medications, or be at risk for falling down. Most seniors will want to remain in their own home or not feel like a burden in their children's home. They resist the loss of independence that a supervised living environment creates. When utilizing an agency to provide your caregiver, be sure to review all of the expectations of care and work with the agency to determine the appropriate level of care to meet your needs.

If you find yourself in the situation where you need to become the family's expert in home health care issues and are feeling overwhelmed, contact Assisted and they will guide you through the process. We will treat the members of your family like they were members of our family.

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THE FOUNTAIN OF YOUTH IS FOUND IN EXERCISE – AT ANY AGE
by Sherry Netherland

I have worked with seniors and their healthcare issues for a long time. The best advice I can give you is don't grow old. Don’t get me wrong, I am not advising you against aging, unless, of course, you have figured out how to stop the clock ticking. If you have, I'll trade you winning lottery numbers! I am suggesting, however, that you can age more slowly if you have a lifestyle of increased activity and proper nutrition. In the study, "Disuse and Aging," Dr. Walter M. Bortz concluded, "at least a portion of the changes that are commonly attributed to aging are, in reality, caused by immobility. As such, they're subject to correction by mobility – meaning activity and exercise."

When discussing this article with one of my co-workers who is in her early 50's, her response was, "Exercise? Ugh!" So, how do you convince someone, don't be in your 60's wishing you had taken better care of yourself in your 50's? Even though this article is focusing on the need for exercise in the senior population, how many of us younger than the mid-century mark are getting a head start on a fitness lifestyle? I don't think there will be anyone reading this article who is not aware of the need to exercise more in order to stay fit, or get fit. Unfortunately, too many of us will wait until we have a health crisis to get the wake-up call.

Every study of exercising seniors demonstrates that they will report fewer chronic illnesses which may impair the quality of their lives. There is good news for couch potatoes, though – it is never too late to start, and that remains true even for adults in their 60's, 70's, 80's and 90's.

A 1990 study, published by Dr. Maria Fiatarone, in the Journal of the American Medical Association, took 10 frail elderly men and women (aged 87-96 years old) all living in a nursing home and provided them with an intensive 8-week strength building program. At the end of the eight weeks, their leg strength tripled and their thigh muscles increased by more than 10%. There was a dramatic improvement in their perceived quality of life by increasing their independence and general feeling of well-being.

As we view our aging parents, how do we rate their independence along the continuum? For some, it's staying active and continuing to live in their own home, for others it's being able to feed themselves and go to the bathroom unassisted.

A common concern voiced by seniors is their desire not to be a burden to their children. If they are involved in a program of regular exercise this can be an achievable goal, because the key to any fitness program targeting seniors is achieving and maintaining functional independence.

An exercise program can be specifically geared to improve balance and greatly reduce their risk of falling by strengthening the trunk and leg muscles. Imagine how beneficial leg strength is for seniors who need to get up in the middle of the night to use the bathroom. Not only could they get there in time, but strong thigh muscles will get them on and off the commode with ease.

We will all experience a reduction in reaction times with age. A regular fitness regimen can actually increase reaction times. This would be particularly important to those seniors who are still driving.

Osteoperosis, commonly thought of as a condition of post-menopausal women, can also affect men. Weight bearing or resistance exercise can help reduce the risk of oteoperosis and has been proven to increase bone density.

The benefits of weight resistance programs can also be achieved with pool exercise. The pool is a wonderful environment for safe, stable, weight resistance training, particularly for those seniors with balance concerns.

Exercise also increases lean muscle mass. With an increase in muscle mass comes an increase in metabolism which increases fat burning. There will also be an increase in aerobic capacity because you will have more muscles consuming oxygen, ergo, an increase in cardiovascular health.

If you are not currently engaged in an exercise routine, please consult with your physician before you begin. If you haven't exercised in a long time, start small. Don't risk injury. I can guarantee you that starting with even the simplest exercise, like walking around the block everyday, will yield results.

So, walk around the mall, take the stairs instead of the elevator. (Do I need to say quit smoking?) Experiment with different exercises. I have always believed that if you don't like exercise it's because you haven't found something you like to do. When you find something you like and do it regularly, you can't help but love the positive effects it will have on your appearance, mood, and health. Mr. Spock said, "Live long and prosper." I say, "Live long and healthy."

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HOSPICE CARE: AN OPTION AT THE END-OF-LIFE
by Sherry Netherland

We will all do two things in our lives – pay taxes and die. We do the very best we can to plan for our taxes, why don't we do as much to plan for our death? National Hospice Foundation statistics show that Americans are more likely to talk to their kids about drugs and sex than they are to talk with their parents about death. Fewer than 25% of us have thought about how we would like to be cared for at the end of life and put it in writing. Even though nearly 36% of people will claim that they have told someone how they would like to be treated, in reality it is more likely that that information was communicated as a passing comment. One out of every two people interviewed said they would rely on family and friends to make decisions for them at the end of life, yet none of them have talked about their wishes! To compound the problem further, these same interviewees feel that enforcing the patient's own wishes when they are sick with less than six months to live is the most precious thing you can provide to a loved one.

Dr. Stuart Lazarus of the National Hospice Foundation reveals that despite the fact that hospice care has been successful in America for more that two decades, one-third of Americans do not know that only hospice offers what people say they want when dealing with a terminal illness and limited life expectancy: choice in care, control of pain, medical attention, help for the family, spiritual and emotional support, and the option to remain in their own home.

Hospice is both a service and a philosophy. Hospice embraces the philosophy that quality of life is much more important than quantity and emphasizes caring rather than curing. The patient and their family have been informed of the diagnosis and they understand that continuing therapy will be palliative rather than curative in nature. The patient is no longer seeking active treatment for their disease. The primary goal is to provide comprehensive care to those terminally ill and to their families, helping them to continue life as normally as possible. Hospice care should allow the patient to die peacefully and with dignity.

Hospice is unique in its approach to patient care. It embraces the whole person and their family. Their emotional, physical, and spiritual needs are the primary focus. Quality hospice care relies upon a team approach. Members of a patient's hospice care team include:

1. The patient's attending physician.
2. The hospice medical director - contributes specialized expertise in pain and symptom management and participates in the development in the individualized plan of care
3. The social worker - provides counseling and linkage to community services which will assist the patient and family develop coping strategies.
4. Spiritual counselors if desired.
5. The Registered Nurse - identifies physical, psycho-social and environmental needs of the terminal patient and addresses symptom management and comfort
6. The certified home health aide - assists the patient with hygiene, feeding, light housekeeping and similar personal care activities.
7. Volunteers - provide practical help, friendship and support to the patient and their family.
8. Registered dietician – provides nutritional counseling, as the food and fluid intake needs change with terminal illness.

Since 1983, hospice has been fully reimbursable under Medicare Part A. Since that time, many private health insurance companies have followed suit by adding hospice care to their plans of coverage.

Home hospice care can be accessed wherever a patient resides. In addition to the patient's own home, hospice care can be provided in a skilled nursing facility, board and care home, assisted living facility or retirement home.

How many of you reading this article right now have talked with your family members about what you want when faced with terminal illness? Do you have a durable power of attorney for health care in place? Have you made funeral arrangements? It is very difficult for adult children to discuss of end-of-life issues with their parents. The National Hospice and Palliative Care Organization recommends an "asking permission" approach. Some suggestions are, "I'd like to talk about how you would like to be cared for if you got really sick. Is that okay?," or, "If you ever got sick, I would be afraid of not knowing the kind of care you would like. Could we talk about this now? I'd feel better if we did." You really will.

If you need more information about home hospice care and are feeling overwhelmed, contact Assisted Home Hospice at 800-499-6664 and they will guide you through the process.

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"Shorter Hospital Stays? No Problem!"
by Sherry Netherland

There has been a growing awareness in our country that long hospital stays are a thing of the past. In the 50's, my mother was in the hospital for two weeks when she had her children by C-section, now it's a three day stay. Even though some may feel that drive-through brain surgery is just around the corner, a short hospital stay is not necessarily a bad thing. It is an accepted truth in the health care industry that patients have better outcomes if brought home early. Part of the reason for this enhanced recuperation at home is the advent of home health care.

November is National Home Care and Hospice Month. Statistics gathered by the California Association for Health Services at Home (CAHSAH) reveal that more than 20,000 home care and hospice providers are currently delivering these services in California. "Home health visits were provided to 510,067 patients in California, preventing, postponing and limiting the need for them to be institutionalized to receive these services."

Medicare is the payor source for the majority of these patients. According to the California Department of Aging, by 2010, 1 in 5 Californians will be age 60 or over. California is home to the largest elderly population in the country.

In October, 2000, Medicare instituted revolutionary changes in reimbursement for the home health care industry. In the past, payment was cost-based, fee-for-service, retrospective payments. Now, reimbursement is by a Prospective Payment System (PPS). A system similar to the hospital DRGs (Diagnostic Related Groups), home healthcare reimbursement uses HHRGs (Home Health Related Groups). Since the payments are prospective, the reimbursement is based upon the patient's acuity level at the start of care.

Simply put, hospital stays based upon DRGs means, X diagnosis = X number of days in the hospital. Changes to the pre-determined length of stay are usually predicated upon an individual patient's complications. The same is now true for home health utilization. So, X diagnosis = X number of home visits by a nurse and/or therapist.
Changes to the HHRG are usually determined by the patient's need for additional services, such as therapy, or a change of condition.

The key to HHRG computation is OASIS – Outcome and Assessment Information Set. This assessment tool is done at the initial patient visit. It is designed to provide CMS, the Center for Medicare and Medicaid Services (formerly HCFA) with case mix data. The data includes a clinical score (diagnosis), a functional score (how well can a patient perform activities of daily living, ADLs), and a service utilization score (e.g., a need for physical therapy).

The services allowed by Medicare home health benefits include: skilled nursing, physical therapy, occupational therapy, speech therapy, medical social worker, and home health aide (bath visits).

The Medicare coverage criteria for home health has not changed.

1. The patient must be homebound – This is defined as being unable to leave the home "at will." For some patients, home care is provided during that transitional period from hospitalization to outpatient care.
2. The Patient must need skilled intervention - This is defined as care that falls within the scope of practice of a Registered Nurse, Physical Therapist and/or Speech Pathologist. At least one of those three specialties must be on the case to qualify a patient as having a medical need as defined by their Medicare home health benefit. Patients require services because of acute illness, long-term health conditions, permanent disability, or terminal illness. Bath visits may be appropriate during the time skilled intervention is occurring, but once a patient is discharged from those skilled services, the Medicare covered bath visits end. This skilled need criterion is the number one source of confusion for home care consumers. If the only service needed is a bath, Medicare will consider that custodial care and not a covered benefit.
3. The services provided must be medically necessary. Medicare is designed to be restorative or rehabilitative, it is not a maintenance program. If a patient reaches a plateau with no further improvement, even if they have not achieved pre-illness status, service must be discontinued.
4. The patient's physician determines all care necessary. A home health agency nurse is the eyes and ears of a doctor in the patient's home. The home nursing assessment and home care plan is a vital tool for the physician in directing patient care.

Sherry Netherland, MA, is the Director of Special Projects for Assisted.